Fracture
A break in the structural continuity of bone (but we have to remember
that there is always some degree of soft tissue injury with a fracture)
🔹
Goals of fracture treatment
🔹 Prevent fracture and soft tissue complications Types of Fracture.…cont.
Get fracture to heal and in satisfactory position for optimal 🔹Open fracture:
🔹
functional recovery
Intra-articular fracture needs accurate reduction & rigid fixation
but non articular fracture of bone require anatomical reduction &
When the bony fragments are exposed to
external
🔹
stable fixation.
Rehabilitate as early as possible by active
🔹
environment by means of wound
Closed fracture :
The fracture fragments are not
🔹
& passive exercises.
Restore patient to optimal functional state
exposed to outside
How fracture happen
1.A single traumatic incident
2.Repetitive stress
3. Abnormal weakening of the bone (pathological fracture)
Anatomy
•Shaft extends from the insertion of the pectoralis major to
supracondylar ridge distally.
•The radial nerve crosses the posterior aspect of the humorous
starting approximatly (20cm) from the medial epicondyl.
•The nerve in direct contact with the posterior aspect of the
homeruns for long of approximately 6.5cm without loss of
significant function. 🔹 Types Of Injury:
High energy
•The musculature around the humerus will accommodate (200)
of anterior angulations and (300) of varus angulations without Low energy
compromising function or appearance Easily accept (150) of
malrotation.
•The normal mobility in shoulder and elbow will compensate for 🔹
Management of the iniured patient
🔹 Don’t treat the X-rays of the fracture, but treat the patient
Life saving measures
this degree of deformity.
•(3cm) of shortening can be accepted. -Diagnose and treat life threatening injuries (head injuries, Chest & abdominal injuries)
-Emergency orthopaedic involvement
• Life saving
🔹
•Complication saving
🔹 Emergency orthopaedic management (day1) Monitoring of fracture (days to weeks)
Rehabilitation and treatment of complications (weeks to months)
ATLAS PROTOCOL
A= Airway and cervical spine immobilisation
B = Breathing
C = Circulation (treatment and diagnosis of cause)
D = Disability (head injury)
E = Exposure (musculo-skeletal injury)
Maintain reduction -
gustilo anderson classification Classification
🔹 According fracture personality
🔷 external method:
1) POP
•Transverse
•Oblique
•Segmental
🔹
Mould with palms-
Advantage:
🔹 Follow up of treatment by POP
🔹
•Comminuted
According associated soft tissue injury (Gustilo)
🔹
cheap,easy to use, convenient, can be moulded
Disadvantage:
susceptibility to damage (disintegrates when wet), up to 48hrs to dry,
•Judge each case on its own merits
•Sticky-“Deformable but not displaceable”
Open •Union (weeks)
Grad 1 Fractures of the humeral difficulty to care of open wound
-Incomplete repair; Part moves as
Grad 2
Grad3
shaft 🔹
2) Resin cast
Advantage:
lighter and stronger, more resistant to damage, sets in 5-10mins, max
one; Local tenderness; Local pain on stress; See
fracture line on-x-ray
🔹
Close
According intrinsic conditions of the bone Normal
Pathologic
🔹
strength in 30mins
Disadvantage:
•Consolidation (months)
- Complete repair; No external protection needed;
Upper limb 6/52; Lower limb 12/52; Half for child;
cost, more difficult to apply/remove, more rigid with greater risk of
Metabolic Double for transverse fractures
complications eg. swelling and pressure necrosis
Metastatic •Remodelling (years) successfully occur in growing
😁
3) Surface traction
Infectious skeleton
•Temporary measure when operative fixation not available for awhile
introduction • Skin can be injured if applied for long periods of time
🔹Operative treatment •Neuro-vascular status should be checked during surface traction period
4)Skeletal traction
Indications for operative treatment
🔹 Current absolute indications:
indications: •Requires invasive procedure for longer term traction requiring heavier •Polytrauma; Displaced intra-articular fractures
1. Failure of closed reduction . Management weights •Open fractures with vascular injury or compartment
2. Intra-articular extension.
Several variables effect the treatment plan: Diagnosis Reduction •Complications associated with pin insertion eg. infection syndrome
3.Vascular injury or compromise.
4. Associated ipsilatral forearm
fractures( Floating)elbow
- Fracture pattern.
- Degree of soft tissue injury.
History and physical examination : Falls
Twisting injuries
If necessary, what reduction technique?
1) Closed reduction 🔹
5) External fixator
Indications:
•Fractures associated with soft tissue injury
🔹
•Pathological fractures and non-union
Current relative indications:
associated Neurological injury. Pedestrian or motor vehicle crashes -Need anaesthesialsedation, analgesia, x-ray facilities, equipment, •Loss of position with closed method; Poor functional
5.Segmental fractures. Radiographic Exam: knowledge •Fracture associated with N/V damage result with non-anatomical reduction; Displaced
- Patient age.
6. Pathologic fractures. Two views at (90°) to one another Including -Used for minimally displaced fractures and most fractures of children •Severely comminuted and unstable fracture fractuges with poor blood supply
-CO -morbidity.
7. Bilateral fractures. shoulders and elbow in each view. •Distal part of limb pulled in line of bone •Unstable pelvic fracture
- Patient complained.
8. Open fracture.
9. Poly trauma:- 🔹 Nonoperative treatment
Most humoral shaft fractures managed non-
•Alignment adjusted in each plane
2) Open reduction 🔹
•Infected fracture For skin graft & flap coverage
Complications:
- Head injuries -Above + theatre staff+ additional equipment •Pin track infection •Delayed union
- Burns operatively with union rate approaching (100)percent.
Due to tolerance of malunions, good -Risks
- Chest trauma
- Multiple fractures
10.Parkinson's disease.z
healing non wt bearing bone.
Methods: 🔹 Maintain reduction
Methods
1- Functional fracture bracing . (The most use).
2- Coaptation splint.
•Necessary for ?
1) Relieve pain 🔷
🔹 internal method
Advantages:
3- Hanging arm cast( not commonly used). 2) Prevent mal-union - nature heals the fracture, we keep it in a good
1- Intra medullar nailing position -Restoration of absolute anatomical state
2- Plating 4- Siling.
5- Abduction cast. 3) Minimise non-union - maintenance of reduction should be continuous -Shorter hospital stay
3- External fixation
if open reduction is chosen plate
fixation remains the gold standard
6- Skeletal traction. •How?
-1) External method
. POP (+ equivalents), traction, external fixator
🔹
-Enables individuals to return to function earlier
Indications:
-Fractures that need operative fixation
method of internal fixation -2) Internal method -Inherently unstable fractures prone to re- displacement after reduction
Wires, pins, plates, nails, screws (eg. mid-shaft femoral fractures)
-Pathological fracture
-Polytrauma (minimise ARDS)
Treatment
🔹 Nonoperative All our management to ensure forearm motion. Can be viewed as
🔹
-Patients with nursing difficulties (paraplegics, v. elderly, multiple trauma)
Complications
-Infection
in adult: intra-articular fractures with forearm (Joint) providing supination - Non-union
1- Isolated ulnar shaft fracture , Non and pronation . - Implant failure
displacement or minimal displacement to (25) •So unsatisfactory treatment can lead to loss of motion , muscle - Re-fracture
percent of shaft width imbalance and disability of hand function .
2- Non-displaced radial shaft fractures.
Method :
Long arm plasters cast for (8) to (10) weds .
Goals of treatment 🔹
By.. Nail , plate , screws, ware.
Wires & pins:
- Can be used in conjunction with other forms of internal fixation
1- Anatomic reduction, Restoring bone lengthen, Rotation and
🔹 operative treatment
All displaced fractures of the diaphysis of
interosseous space
2- Secure fixation to enable earlysoft tissue rehabilitation 🔹
- Used to treat fractures of small bones
Plates & screw:
- Extend along the bone and screwed in place
the radius or ulna of both are manged by Surgical classification - May be left in place or removed (in selected cases) after healing is
open reduction and internal fixation.
Methods:
Proximal Third.
🔹
complete
Nail or rods:
🔹
Middle Third. TREATMENT PRINCIPLE OF FRACTURE
Plating gold stander -Held in place by screws until the fracture is healed
🔹
Distal Third. Reduction
Nailing (rare) - May be left in the bone after healing is completed
External fixation for open fracture high grad. 🔹 Maintain reduction (+ hold until union)
🔹Rehabilitate - restore function by movement of the joint & patient itself.
Prevent or treat complications
Stages of Fracture Healing
🔹
•It is fracture of distal radius with subluxation or Open (Compound) Fractures •Inflammation & Hematoma
dislocation of the DRUJ(distal radio ulnes joint)
•It's an common. Management of 🔹 High risk of infection
Can be associated with gross soft tissue damage, severe haemorrhage or vascular injury
•Callus Formation
•Woven Bone
long boneshaft 🔹
MANAGEMENT •Remodeling
fracture 🔹
🔹
While contacting orthopaedic team for definitive surgical treatment
🔹
Types of fracture healing
irrigate wound with N.saline, if not available with tap water. Cover wound with sterile moist dressing.
Immobilise limb preferable with external fixator if not possible , by pos. cast(including joint above '& Primary :
The following radiographic findings suggest
🔹
below)
🔹
healing of the bone occur by interstitial growth of bone in rigid fixation by
🔹
traumatic disruption of the DRUJ in presence of Remove obvious contaminants with meticulous effort plate or nail
isolated fracture of the radial diaphysis:
1- Fracture of ulnar styloid. 🔹
🔹
Take photos
IV antibiotics (e.g. cefuroxime +/- metronidazole or gentamicin)
Secondary :
healing occurs with adequate callus formation both interstitial &
2- Widening of DRUJ space in Ap. View.
3- Dislocation of the radius on lateral view. Galeazzi fracture Dislocation 🔹 Tetanus prophylaxis.
🔹Check distal neurovascular status
surrounding, when micro movement occur in stable fixation by POP, cast,
locking plate, external fixator.
Shortening of the radius beyond 5 mm relative to the Fractures of the forearm shaft Re-assess -Modern concept is …secondary healing is preferable except intra-articlar
distal ulna.
🔹
(Diaphysis) fracture
Factors Influencing Healing
systemic Factors
•Age •Hormones •Functional activity •Nerve function •Nutrition •Drugs
🔹 Treatment :
Operative method it termed as
(NSAID)
Local Factors
•Energy of trauma •Degree of bone loss •Vascular injury •Infection •Type of
🔹
fracture of necessity.
Method:
Plating with minimum of five 🔹
bone fractured •Degree of immobilization •Pathological condition
Fracture healing -operative
and preferably six screws. 1) Reduction and compression
Primary bone healing
🔹 The open reduction and plat
fixation of radius fractures will
Slow process, rehabilitation rapid, high risk
2) Nailing or external fixation
reduce the DRUJ subluxation or Healing by callus
Rapid process, rehabilitation rapid, lesser risk
dislocation spontaneously.
🔹 Healing Complications
•Delayed union
Classifid as the direction of the dislocation Fracture of proximal ulna with dislocation of •Nonunion
of the head of the radius : the radial head. •Malunion
Anterior
•Post -traumatic arthritis
Posterior
•Growth abnormalities
Lateral
•Fracture diseases- joint stiffness, non-uses"atrophy, Sudeck osteo-
as anterior dislocation of the radial head with
dystrophy,
fracture of both ulna and radius at proximal
third of the forearm .
Treatment
monteggia fracture dislocation 🔹 Rehabilitation
•Restore the patient as close to pre-injury
1- Non operative treatment with close reduction and p.o.p casting functional level as possible
remains stander for most pediatric fractures. •Rest, Elevation, Mobilisation
2- Operative treatment with open reduction and internal fixation by (active/passive)
plating is mandatory in audit patient , with anatomical reduction of ulnas •Physiotherapy,
fracture and fixed by plate to ensure accurate repositioning of the radial •Work assessment and re-employment
head
Ultranative by IM rods.
1- Weight bearing bone.
2- It has subcutaneous antero-medial surface.
•The Femur is the longest and strongest bone in 3-Theyare slow to heal.
the body 4- Frequently cause permanent sequellae.
•The diaphysis (shaft) is tube with smoth 5- Common association with:
definite anterio-posterior bow. -Compartment syndrome.
-Neuro-vascular injury.
🔹Nonoperative with closed method of -Myotendinous units
treatment
It used for many years as definitive treatment.
Tibial shaft fractures 🔹 1- Nonoperative management of less sever
But today commonly use as temporizing measure .
-Control limb length . 🔹
injuries byposterior slapthen p.o.p casting.
2- Adequate depridement in open fracture
and stabilization by EXT fix in sever form or in
-Alignment.
-Relief pain. typel, Il in non Contamint wound by early IM
-Prior to surgical stabilization.
🔹
nailing.
3- In displaced fractures IM nailing is thegold
🔹 Operative treatment 🔹
standers
Alternative to IM nailing are
- IM nailing is the qold standard treatment of femoral Femoral shaft fractures - Plating
diaphysealfracture, today locking system is the best. Iypes:
- Extrnal fixation.
1- Standerd IM nail without locking (not used in most countries today).
2- Anatomically intra-modularly nail with locking
swes system :
Ante grad
Retrogrades
3- Reconstruction nailing
•Open reduction and internal fixation with plates it popularized in
60s and 70s, but are more rarely used for femoral fixation in recent
years because of the established success of femoral nailing. Principles of management of diaphyseal
•Specific instance when plating still has role femoral
1- Femurs fracture in immature femurs. fractures
2- Fracture extension to articular surface. Patient with isolated an complicated femoral -fractures
3- Treatment of nonunions. should have their fracture temporarily stabilized with:
4- With prosthetic implant in place. -Traction splint
-Posterior splint of p.o.p
types: -And have definitive care as soon as it is practical .
1- DCP dynamic compression plat.
2- Low contact plat.
3- Minimally invasive per cetaceous plate osteosynthesis or MIPPO
4- Less invasive stabilization system (Liss plat)
External fixation
AO External fixation.
illzarove External fixation.
Indication:
1- Temporary stabilization in polytrauma.
2- Sever open fracture
3- Stabilization prior to transfer
4- Definitive treatment in skeletally immature patients
by fatema okoff in open femur fractures standard teachings
includes:
- Debridement.
-Irrigation and lavage.
-Skeletal stabilization. usually by EX. Fix
-Early healthy soft tissue cover
A break in the structural continuity of bone (but we have to remember
that there is always some degree of soft tissue injury with a fracture)
🔹
Goals of fracture treatment
🔹 Prevent fracture and soft tissue complications Types of Fracture.…cont.
Get fracture to heal and in satisfactory position for optimal 🔹Open fracture:
🔹
functional recovery
Intra-articular fracture needs accurate reduction & rigid fixation
but non articular fracture of bone require anatomical reduction &
When the bony fragments are exposed to
external
🔹
stable fixation.
Rehabilitate as early as possible by active
🔹
environment by means of wound
Closed fracture :
The fracture fragments are not
🔹
& passive exercises.
Restore patient to optimal functional state
exposed to outside
How fracture happen
1.A single traumatic incident
2.Repetitive stress
3. Abnormal weakening of the bone (pathological fracture)
Anatomy
•Shaft extends from the insertion of the pectoralis major to
supracondylar ridge distally.
•The radial nerve crosses the posterior aspect of the humorous
starting approximatly (20cm) from the medial epicondyl.
•The nerve in direct contact with the posterior aspect of the
homeruns for long of approximately 6.5cm without loss of
significant function. 🔹 Types Of Injury:
High energy
•The musculature around the humerus will accommodate (200)
of anterior angulations and (300) of varus angulations without Low energy
compromising function or appearance Easily accept (150) of
malrotation.
•The normal mobility in shoulder and elbow will compensate for 🔹
Management of the iniured patient
🔹 Don’t treat the X-rays of the fracture, but treat the patient
Life saving measures
this degree of deformity.
•(3cm) of shortening can be accepted. -Diagnose and treat life threatening injuries (head injuries, Chest & abdominal injuries)
-Emergency orthopaedic involvement
• Life saving
🔹
•Complication saving
🔹 Emergency orthopaedic management (day1) Monitoring of fracture (days to weeks)
Rehabilitation and treatment of complications (weeks to months)
ATLAS PROTOCOL
A= Airway and cervical spine immobilisation
B = Breathing
C = Circulation (treatment and diagnosis of cause)
D = Disability (head injury)
E = Exposure (musculo-skeletal injury)
Maintain reduction -
gustilo anderson classification Classification
🔹 According fracture personality
🔷 external method:
1) POP
•Transverse
•Oblique
•Segmental
🔹
Mould with palms-
Advantage:
🔹 Follow up of treatment by POP
🔹
•Comminuted
According associated soft tissue injury (Gustilo)
🔹
cheap,easy to use, convenient, can be moulded
Disadvantage:
susceptibility to damage (disintegrates when wet), up to 48hrs to dry,
•Judge each case on its own merits
•Sticky-“Deformable but not displaceable”
Open •Union (weeks)
Grad 1 Fractures of the humeral difficulty to care of open wound
-Incomplete repair; Part moves as
Grad 2
Grad3
shaft 🔹
2) Resin cast
Advantage:
lighter and stronger, more resistant to damage, sets in 5-10mins, max
one; Local tenderness; Local pain on stress; See
fracture line on-x-ray
🔹
Close
According intrinsic conditions of the bone Normal
Pathologic
🔹
strength in 30mins
Disadvantage:
•Consolidation (months)
- Complete repair; No external protection needed;
Upper limb 6/52; Lower limb 12/52; Half for child;
cost, more difficult to apply/remove, more rigid with greater risk of
Metabolic Double for transverse fractures
complications eg. swelling and pressure necrosis
Metastatic •Remodelling (years) successfully occur in growing
😁
3) Surface traction
Infectious skeleton
•Temporary measure when operative fixation not available for awhile
introduction • Skin can be injured if applied for long periods of time
🔹Operative treatment •Neuro-vascular status should be checked during surface traction period
4)Skeletal traction
Indications for operative treatment
🔹 Current absolute indications:
indications: •Requires invasive procedure for longer term traction requiring heavier •Polytrauma; Displaced intra-articular fractures
1. Failure of closed reduction . Management weights •Open fractures with vascular injury or compartment
2. Intra-articular extension.
Several variables effect the treatment plan: Diagnosis Reduction •Complications associated with pin insertion eg. infection syndrome
3.Vascular injury or compromise.
4. Associated ipsilatral forearm
fractures( Floating)elbow
- Fracture pattern.
- Degree of soft tissue injury.
History and physical examination : Falls
Twisting injuries
If necessary, what reduction technique?
1) Closed reduction 🔹
5) External fixator
Indications:
•Fractures associated with soft tissue injury
🔹
•Pathological fractures and non-union
Current relative indications:
associated Neurological injury. Pedestrian or motor vehicle crashes -Need anaesthesialsedation, analgesia, x-ray facilities, equipment, •Loss of position with closed method; Poor functional
5.Segmental fractures. Radiographic Exam: knowledge •Fracture associated with N/V damage result with non-anatomical reduction; Displaced
- Patient age.
6. Pathologic fractures. Two views at (90°) to one another Including -Used for minimally displaced fractures and most fractures of children •Severely comminuted and unstable fracture fractuges with poor blood supply
-CO -morbidity.
7. Bilateral fractures. shoulders and elbow in each view. •Distal part of limb pulled in line of bone •Unstable pelvic fracture
- Patient complained.
8. Open fracture.
9. Poly trauma:- 🔹 Nonoperative treatment
Most humoral shaft fractures managed non-
•Alignment adjusted in each plane
2) Open reduction 🔹
•Infected fracture For skin graft & flap coverage
Complications:
- Head injuries -Above + theatre staff+ additional equipment •Pin track infection •Delayed union
- Burns operatively with union rate approaching (100)percent.
Due to tolerance of malunions, good -Risks
- Chest trauma
- Multiple fractures
10.Parkinson's disease.z
healing non wt bearing bone.
Methods: 🔹 Maintain reduction
Methods
1- Functional fracture bracing . (The most use).
2- Coaptation splint.
•Necessary for ?
1) Relieve pain 🔷
🔹 internal method
Advantages:
3- Hanging arm cast( not commonly used). 2) Prevent mal-union - nature heals the fracture, we keep it in a good
1- Intra medullar nailing position -Restoration of absolute anatomical state
2- Plating 4- Siling.
5- Abduction cast. 3) Minimise non-union - maintenance of reduction should be continuous -Shorter hospital stay
3- External fixation
if open reduction is chosen plate
fixation remains the gold standard
6- Skeletal traction. •How?
-1) External method
. POP (+ equivalents), traction, external fixator
🔹
-Enables individuals to return to function earlier
Indications:
-Fractures that need operative fixation
method of internal fixation -2) Internal method -Inherently unstable fractures prone to re- displacement after reduction
Wires, pins, plates, nails, screws (eg. mid-shaft femoral fractures)
-Pathological fracture
-Polytrauma (minimise ARDS)
Treatment
🔹 Nonoperative All our management to ensure forearm motion. Can be viewed as
🔹
-Patients with nursing difficulties (paraplegics, v. elderly, multiple trauma)
Complications
-Infection
in adult: intra-articular fractures with forearm (Joint) providing supination - Non-union
1- Isolated ulnar shaft fracture , Non and pronation . - Implant failure
displacement or minimal displacement to (25) •So unsatisfactory treatment can lead to loss of motion , muscle - Re-fracture
percent of shaft width imbalance and disability of hand function .
2- Non-displaced radial shaft fractures.
Method :
Long arm plasters cast for (8) to (10) weds .
Goals of treatment 🔹
By.. Nail , plate , screws, ware.
Wires & pins:
- Can be used in conjunction with other forms of internal fixation
1- Anatomic reduction, Restoring bone lengthen, Rotation and
🔹 operative treatment
All displaced fractures of the diaphysis of
interosseous space
2- Secure fixation to enable earlysoft tissue rehabilitation 🔹
- Used to treat fractures of small bones
Plates & screw:
- Extend along the bone and screwed in place
the radius or ulna of both are manged by Surgical classification - May be left in place or removed (in selected cases) after healing is
open reduction and internal fixation.
Methods:
Proximal Third.
🔹
complete
Nail or rods:
🔹
Middle Third. TREATMENT PRINCIPLE OF FRACTURE
Plating gold stander -Held in place by screws until the fracture is healed
🔹
Distal Third. Reduction
Nailing (rare) - May be left in the bone after healing is completed
External fixation for open fracture high grad. 🔹 Maintain reduction (+ hold until union)
🔹Rehabilitate - restore function by movement of the joint & patient itself.
Prevent or treat complications
Stages of Fracture Healing
🔹
•It is fracture of distal radius with subluxation or Open (Compound) Fractures •Inflammation & Hematoma
dislocation of the DRUJ(distal radio ulnes joint)
•It's an common. Management of 🔹 High risk of infection
Can be associated with gross soft tissue damage, severe haemorrhage or vascular injury
•Callus Formation
•Woven Bone
long boneshaft 🔹
MANAGEMENT •Remodeling
fracture 🔹
🔹
While contacting orthopaedic team for definitive surgical treatment
🔹
Types of fracture healing
irrigate wound with N.saline, if not available with tap water. Cover wound with sterile moist dressing.
Immobilise limb preferable with external fixator if not possible , by pos. cast(including joint above '& Primary :
The following radiographic findings suggest
🔹
below)
🔹
healing of the bone occur by interstitial growth of bone in rigid fixation by
🔹
traumatic disruption of the DRUJ in presence of Remove obvious contaminants with meticulous effort plate or nail
isolated fracture of the radial diaphysis:
1- Fracture of ulnar styloid. 🔹
🔹
Take photos
IV antibiotics (e.g. cefuroxime +/- metronidazole or gentamicin)
Secondary :
healing occurs with adequate callus formation both interstitial &
2- Widening of DRUJ space in Ap. View.
3- Dislocation of the radius on lateral view. Galeazzi fracture Dislocation 🔹 Tetanus prophylaxis.
🔹Check distal neurovascular status
surrounding, when micro movement occur in stable fixation by POP, cast,
locking plate, external fixator.
Shortening of the radius beyond 5 mm relative to the Fractures of the forearm shaft Re-assess -Modern concept is …secondary healing is preferable except intra-articlar
distal ulna.
🔹
(Diaphysis) fracture
Factors Influencing Healing
systemic Factors
•Age •Hormones •Functional activity •Nerve function •Nutrition •Drugs
🔹 Treatment :
Operative method it termed as
(NSAID)
Local Factors
•Energy of trauma •Degree of bone loss •Vascular injury •Infection •Type of
🔹
fracture of necessity.
Method:
Plating with minimum of five 🔹
bone fractured •Degree of immobilization •Pathological condition
Fracture healing -operative
and preferably six screws. 1) Reduction and compression
Primary bone healing
🔹 The open reduction and plat
fixation of radius fractures will
Slow process, rehabilitation rapid, high risk
2) Nailing or external fixation
reduce the DRUJ subluxation or Healing by callus
Rapid process, rehabilitation rapid, lesser risk
dislocation spontaneously.
🔹 Healing Complications
•Delayed union
Classifid as the direction of the dislocation Fracture of proximal ulna with dislocation of •Nonunion
of the head of the radius : the radial head. •Malunion
Anterior
•Post -traumatic arthritis
Posterior
•Growth abnormalities
Lateral
•Fracture diseases- joint stiffness, non-uses"atrophy, Sudeck osteo-
as anterior dislocation of the radial head with
dystrophy,
fracture of both ulna and radius at proximal
third of the forearm .
Treatment
monteggia fracture dislocation 🔹 Rehabilitation
•Restore the patient as close to pre-injury
1- Non operative treatment with close reduction and p.o.p casting functional level as possible
remains stander for most pediatric fractures. •Rest, Elevation, Mobilisation
2- Operative treatment with open reduction and internal fixation by (active/passive)
plating is mandatory in audit patient , with anatomical reduction of ulnas •Physiotherapy,
fracture and fixed by plate to ensure accurate repositioning of the radial •Work assessment and re-employment
head
Ultranative by IM rods.
1- Weight bearing bone.
2- It has subcutaneous antero-medial surface.
•The Femur is the longest and strongest bone in 3-Theyare slow to heal.
the body 4- Frequently cause permanent sequellae.
•The diaphysis (shaft) is tube with smoth 5- Common association with:
definite anterio-posterior bow. -Compartment syndrome.
-Neuro-vascular injury.
🔹Nonoperative with closed method of -Myotendinous units
treatment
It used for many years as definitive treatment.
Tibial shaft fractures 🔹 1- Nonoperative management of less sever
But today commonly use as temporizing measure .
-Control limb length . 🔹
injuries byposterior slapthen p.o.p casting.
2- Adequate depridement in open fracture
and stabilization by EXT fix in sever form or in
-Alignment.
-Relief pain. typel, Il in non Contamint wound by early IM
-Prior to surgical stabilization.
🔹
nailing.
3- In displaced fractures IM nailing is thegold
🔹 Operative treatment 🔹
standers
Alternative to IM nailing are
- IM nailing is the qold standard treatment of femoral Femoral shaft fractures - Plating
diaphysealfracture, today locking system is the best. Iypes:
- Extrnal fixation.
1- Standerd IM nail without locking (not used in most countries today).
2- Anatomically intra-modularly nail with locking
swes system :
Ante grad
Retrogrades
3- Reconstruction nailing
•Open reduction and internal fixation with plates it popularized in
60s and 70s, but are more rarely used for femoral fixation in recent
years because of the established success of femoral nailing. Principles of management of diaphyseal
•Specific instance when plating still has role femoral
1- Femurs fracture in immature femurs. fractures
2- Fracture extension to articular surface. Patient with isolated an complicated femoral -fractures
3- Treatment of nonunions. should have their fracture temporarily stabilized with:
4- With prosthetic implant in place. -Traction splint
-Posterior splint of p.o.p
types: -And have definitive care as soon as it is practical .
1- DCP dynamic compression plat.
2- Low contact plat.
3- Minimally invasive per cetaceous plate osteosynthesis or MIPPO
4- Less invasive stabilization system (Liss plat)
External fixation
AO External fixation.
illzarove External fixation.
Indication:
1- Temporary stabilization in polytrauma.
2- Sever open fracture
3- Stabilization prior to transfer
4- Definitive treatment in skeletally immature patients
by fatema okoff in open femur fractures standard teachings
includes:
- Debridement.
-Irrigation and lavage.
-Skeletal stabilization. usually by EX. Fix
-Early healthy soft tissue cover
